Medical residency in the US – how tough is it?

Lately, some people have been asking me about postgraduate residency programs in the US. Most of them are Nizhnians, but there is one from Volgograd as well :)

Since I’ve wrote about postgraduate studies in Malaysia, Australia, New Zealand, UK etc, might as well I write about the US. Please be reminded that whatever I write here can be wrong, so please verify everything yourself.

  1. Some people think passing the qualifying medical examinations for practicing medicine in the US – USMLE or United States Medical Licensing Examination is already enough to get a residency. While USMLE is the core factor for residency in the US, passing the Step 1, Step 2 CK (Clinical Knowledge) and Step 2 CS (Clinical Skills) of USMLE alone is certainly not enough (the points below explain the not-enough part). The application requires med school insignia (what a pain!). Step 3 of USMLE is usually taken during or before the start of residency.
  2. Exam accessories – of course you need to choose excellent review books for USMLE revision. You also don’t want to miss excellent USMLE-oriented revision programs such as Kaplan and question banks for your practice (Kaplan, NBME, USMLE World, USMLERX etc). People spend differently on this, ranging from $800 – $5000.
  3. USCE or United States Clinical Experience is looked upon quite highly for residency programs to interview their residency candidates. Most programs require a candidate to have at least 2 LORs (Letters of Recommendations) from US physicians. To obtain the LORs, a candidate must take up externship/subinternship/observership program in US hospitals. You need to pay some $$$ for the program. Some clinical and scientific researches give more weight to the IMGs (International Medical Graduates).
  4. Getting into the US – this can be quite tough with the pencil-pushing bureaucrats in the US embassy/consulate. IMGs need at least THREE TIMES of travel to the US before starting residency. One for USMLE Step 2 CS exam which is only available in the US, one for USCE, and one for residency interview. More $$$ down the drain!! Visas are pain in the ass; some may get visitors visa B1, for those unfortunate ones, they will decline you the visa. For residency visa, you’ll have to choose H1B (6 years of employment) or J1 (7 years of education). To obtain a H1B visa, an IMG has to be reaaaaaalll good for the program to sponsor such visa. J1 visa requires some letters from ministry of Health of IMG’s home country saying that the IMG will return home after 7 years of training. Many IMGs opt for J1.
  5. Application process to a residency program- I haven’t fully understood the whole process, but it’s kinda painful for me tho. With all the pre-match, scrambles, NRMP, ERAS, datelines and timelines, interview processes, final applications, ECFMG certifications and shits like that! Gaaaa that’s too many shits in an IMG’s head.
  6. Interviews – IMGs mostly apply a few programs (10-20) for interview. A typical IMG profile is 4-5 years post graduation, have done at least 2 USCEs and have a few LORs in hand (refer above), 85th percentile and above for USMLE Step 1 and Step 2 CK scores, passed Step 2 CS on first attempt.
  7. Specialties - some specialties are definitely no-no for IMGs, such as radiology, ophthalmology, ortho, anesthesia and dermatology. Most IMGs go for Internal Medicine and Family Medicine since American Medical Graduates (AMGs) opt for easier specialties with higher pays to settle their medical school debts. Internal Medicine and Family Medicine residency usually last 3 years. Many IMGs follow with fellowship programs for their subspecialties since the J1 visa is valid for 7 years. So, 3 years of residency + 2-4 years of fellowship = just nice for an IMG to be called a specialist!
  8. Competition – no doubt it’s gonna be very competitive. Some programs are real tough they only pick those USMLE scores of 90th percentile and above for residency interview. Some specialties like neurology, neurosurgery and surgery are much tougher – 97th – 99th percentile only. A highly respected surgeon from a foreign country can end up being a family medicine physician in the US. Not that I’m looking down to family medicine, but specialties like surgery is definitely tough for IMGs to get in.

Ok I guess this is the shortest summary down to the bare minimum I can give you. Mind you, my knowledge about residency in the US is not even 10% from what other IMGs know! I was soooo overwhelmed when I saw people discussing residency in the US in some forums available throughout the world wide web.

Anyways, if you’re inspired to work in US because you see how happy those surgeons are in Grey’s Anatomy or how genius Dr. House can diagnose a patient; perhaps you should change your inspiration.

And for those who are inspired by fame, respect and money; you definitely won’t get any of that! What you get is probably long-hours of strenuous working with yelling supervisors, sacrificing your time and being very far from your family and friends, changing who you are and many other negative stuffs.

Perhaps I should just be a nurse… ;)

For more information visit www.usmle.org and www.ecfmg.org.

Published in:  on April 26, 2008 at 9:58 pm Comments (7)